scholarly journals Oxygen in the First Minutes of Life in Very Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Ola Didrik Saugstad ◽  
Vishal Kapadia ◽  
Ju Lee Oei
Keyword(s):  
Heart Rate ◽  
Relevant Literature ◽  
Newborn Infants ◽  
Adverse Outcomes ◽  
Delivery Room ◽  
Positive Pressure ◽  
Very Preterm Infants ◽  
Liaison Committee ◽  
Very Preterm ◽  
Increased Risk

Even a few minutes of exposure to oxygen in the delivery room in very preterm and immature infants may have detrimental effects. The initial oxygenation in the delivery room should therefore be optimized, but knowledge gaps, including initial fraction of oxygen (FiO<sub>2</sub>) and how FiO<sub>2</sub> should be changed to reach an optimal oxygen saturation measured by pulse oximetry (SpO<sub>2</sub>) target within the first 5–10 min of life, remain. In order to answer this question, we therefore reviewed relevant literature. For newly born infants with gestational age (GA) &#x3c;32 weeks in need of positive pressure ventilation (PPV) immediately after birth, we identified 2 fundamental issues: (1) the optimal initial FiO<sub>2</sub> and (2) the target SpO<sub>2</sub> within the first 5–10 min of life. For newly born infants between 29 and 31 weeks of GA, an initial FiO<sub>2</sub> of 0.3 hit the target defined by the International Liaison Committee on Resuscitation (ILCOR) best. Newborn infants with GA &#x3c;29 weeks in need of PPV and supplementary oxygen, we suggest starting with FiO<sub>2</sub> 0.3 and adjusting the FiO<sub>2</sub> to reach SpO<sub>2</sub> of 80% within 5 min of life for best outcomes. Prolonged bradycardia (heart rate &#x3c;100 bpm for &#x3e;2 min) is associated with increased risk of adverse outcomes, including death. The combination of strict control of development of SpO<sub>2</sub> in the first 10 min of life and a heart rate &#x3e;100 bpm represents the best tool today to achieve the most optimal outcome in the delivery room of very preterm and immature newborn infants.

scholarly journals 24 Association of location of intubation procedure and number of tracheal intubation attempts with death or severe neurological injury among very preterm infants

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e9-e9
Author(s):  
Anthony Debay ◽  
Sharina Patel ◽  
Pia Wintermark ◽  
Martine Claveau ◽  
François Olivier ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Preterm Infants ◽  
Physiological Stress ◽  
Periventricular Leukomalacia ◽  
Adverse Outcomes ◽  
Neurological Injury ◽  
Multivariable Logistic Regression Analysis ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Increased Risk

Abstract Background The physiological stress induced by tracheal intubation (TI) is associated with increased risk of neurological injury among very preterm infants. The location of TI procedure and number of attempts required may contribute to adverse outcomes. Objectives We aimed to assess the association of location where TI is performed and the number of TI attempts with death and/or severe neurological injury (SNI) among very preterm infants born &lt;33 weeks and intubated in the first 7 days of life. Design/Methods Retrospective cohort study of 442 infants born 23-32 weeks gestation, admitted to a Level 3 NICU 2015-2018 within the first 7 days of life. We excluded infants who were moribund and the ones with a major congenital anomaly. Data was collected from the Canadian Neonatal Network database and chart review. Exposures were location of TI (delivery room [DR] vs. NICU) and number of TI attempts (1 vs. &gt;1) among infants intubated in the first 7 days of life. Primary outcome was death and/or SNI (intraventricular hemorrhage grade 3-4 and/or periventricular leukomalacia). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders. Results Rate of intubation was 46% (202/442). Rate of death and/or SNI was 2.5% (6/240) among infants never intubated, 12% (13/105) among NICU TI, 32% (31/97) among DR TI, 20% (17/85) among infants with 1 TI attempt and 23% (27/117) among infants with &gt;1 TI attempt. Rate of premedication use for NICU TI was 97% (102/105). Overall, median number of intubation attempts was 1 [IQR 1-2]. Compared to no TI, TI in the NICU (adjusted odds ratio [AOR] 3.39, 95% CI 1.20-10.53) and TI in the DR (AOR 9.28, 95% CI 3.33-29.43) were associated with higher odds of death and/or SNI. DR TI was associated with higher odds of death and/or SNI compared to NICU TI (AOR 2.73, 95% CI 1.23-6.35). Compared to no TI, 1 TI attempt (AOR 5.25, 95% CI 1.93-15.93) and &gt;1 TI attempt (AOR 5.17, 95% CI 1.93-15.69) were associated with higher odds of death and/or SNI. The number of intubation attempts (1 vs. &gt;1) was not associated with death and/or SNI (AOR 0.99, 95% CI 0.47-2.09). Conclusion Intubated infants have higher odds of death and/or SNI. Among intubated infants, DR TI is associated with higher odds of death and/or SNI vs. TI in the NICU with premedication. Optimizing non-invasive ventilation in the DR may help reduce brain injury in preterm infants.

3-lead electrocardiogram is more reliable than pulse oximetry to detect bradycardia during stabilisation at birth of very preterm infants

2017 ◽  
Vol 103 (3) ◽  
pp. F233-F237 ◽  
Author(s):  
Beatriz Iglesias ◽  
Marí­a José Rodrí­guez ◽  
Esther Aleo ◽  
Enrique Criado ◽  
Jose Martí­nez-Orgado ◽  
...  
Keyword(s):  
Heart Rate ◽  
Pulse Oximetry ◽  
Preterm Infants ◽  
Study Design ◽  
Neonatal Resuscitation ◽  
Delivery Room ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Video Recordings ◽  
Resuscitation Guidelines

ObjectivesCurrent neonatal resuscitation guidelines suggest the use of ECG in the delivery room (DR) to assess heart rate (HR). However, reliability of ECG compared with pulse oximetry (PO) in a situation of bradycardia has not been specifically investigated. The objective of the present study was to compare HR monitoring using ECG or PO in a situation of bradycardia (HR <100 beats per minute (bpm)) during preterm stabilisation in the DR.Study designVideo recordings of resuscitations of infants <32 weeks of gestation were reviewed. HR readings in a situation of bradycardia (<100 bpm) at any moment during stabilisation were registered with both devices every 5 s from birth.ResultsA total of 29 episodes of bradycardia registered by the ECG in 39 video recordings were included in the analysis (n=29). PO did not detect the start of these events in 20 cases (69%). PO detected the start and the end of bradycardia later than the ECG (median (IQR): 5 s (0–10) and 5 s (0–7.5), respectively). A decline in PO accuracy was observed as bradycardia progressed so that by the end of the episode PO offered significantly lower HR readings than ECG.ConclusionsPO detects the start and recovery of bradycardia events slower and less accurately than ECG during stabilisation at birth of very preterm infants. ECG use in this scenario may contribute to an earlier initiation of resuscitation manoeuvres and to avoid unnecessary prolongation of resuscitation efforts after recovery.

Supporting breathing of preterm infants at birth: a narrative review

2018 ◽  
Vol 104 (1) ◽  
pp. F102-F107 ◽  
Author(s):  
Tessa Martherus ◽  
André Oberthuer ◽  
Janneke Dekker ◽  
Stuart B Hooper ◽  
Erin V McGillick ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Spontaneous Breathing ◽  
Narrative Review ◽  
Delivery Room ◽  
Positive Pressure ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
The Ideal

Most very preterm infants have difficulty aerating their lungs and require respiratory support at birth. Currently in clinical practice, non-invasive ventilation in the form of continuous positive airway pressure (CPAP) and positive pressure ventilation (PPV) is applied via facemask. As most very preterm infants breathe weakly and unnoticed at birth, PPV is often administered. PPV is, however, frequently ineffective due to pressure settings, mask leak and airway obstruction. Meanwhile, high positive inspiratory pressures and spontaneous breathing coinciding with inflations can generate high tidal volumes. Evidence from preclinical studies demonstrates that high tidal volumes can be injurious to the lungs and brains of premature newborns. To reduce the need for PPV in the delivery room, it should be considered to optimise spontaneous breathing with CPAP. CPAP is recommended in guidelines and commonly used in the delivery room after a period of PPV, but little data is available on the ideal CPAP strategy and CPAP delivering devices and interfaces used in the delivery room. This narrative review summarises the currently available evidence for why PPV can be inadequate at birth and what is known about different CPAP strategies, devices and interfaces used the delivery room.

Accuracy of Pulse Oximetry Measurement of Heart Rate of Newborn Infants in the Delivery Room

2008 ◽  
Vol 152 (6) ◽  
pp. 756-760 ◽  
Author(s):  
C. Omar F. Kamlin ◽  
Jennifer A. Dawson ◽  
Colm P.F. O'Donnell ◽  
Colin J. Morley ◽  
Susan M. Donath ◽  
...  
Keyword(s):  
Heart Rate ◽  
Pulse Oximetry ◽  
Newborn Infants ◽  
Delivery Room

scholarly journals Hypertensive Disorders during Pregnancy and Risk of Bronchopulmonary Dysplasia in Very Preterm Infants

2018 ◽  
Vol 36 (02) ◽  
pp. 176-183
Author(s):  
Filipa de Lima ◽  
Ana Machado ◽  
Hercília Guimarães ◽  
Gustavo Rocha ◽  
Keyword(s):  
Arterial Hypertension ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Hypertension ◽  
Newborn Infants ◽  
Chronic Hypertension ◽  
Very Preterm Infants ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
Preterm Babies

Introduction It is not yet fully known whether hypertensive disorders (HTD) during pregnancy impose an increased risk of development of bronchopulmonary dysplasia (BPD) in preterm newborn infants. Objective To test the hypothesis that preeclampsia and other HTD are associated with the development of BPD in preterm infants. Materials and Methods Data on mothers and preterm infants with gestational age 24 to 30 weeks were prospectively analyzed in 11 Portuguese level III centers. Statistical analysis was performed using IBM SPSS statistics 23. Results A total of 494 preterm infants from 410 mothers were enrolled, and 119 (28%) of the 425 babies, still alive at 36 weeks, developed BPD. The association between chronic arterial hypertension, chronic arterial hypertension with superimposed preeclampsia, and gestational hypertension in mothers and BPD in preterm infants was not significant (p = 0.115; p = 0.248; p = 0.060, respectively). The association between preeclampsia–eclampsia and BPD was significant (p = 0.007). The multivariate analysis revealed an association between preeclampsia–eclampsia and BPD (odds ratio [OR] = 4.6; 95% confidence interval [CI] 1.529–13.819; p = 0.007) and a protective effect for BPD when preeclampsia occurred superimposed on chronic arterial hypertension in mothers (OR = 0.077; 95%CI 0.009–0.632; p = 0.017). Conclusion The results of this study support the association of preeclampsia in mothers with BPD in preterm babies and suggest that chronic hypertension may be protective for preterm babies.

Spectral analysis of heart rate variability in spontaneously breathing very preterm infants

1994 ◽  
Vol 83 (5) ◽  
pp. 473-480 ◽  
Author(s):  
C Ravenswaaij-Arts ◽  
J Hopman ◽  
L Kollée ◽  
G Stoelinga ◽  
H Geijn
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Spectral Analysis ◽  
Preterm Infants ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Spontaneously Breathing

Comparison of infant heart rate assessment by auscultation, ECG and oximetry in the delivery room

2018 ◽  
Vol 103 (5) ◽  
pp. F490-F492 ◽  
Author(s):  
Madeleine C Murphy ◽  
Laura De Angelis ◽  
Lisa K McCarthy ◽  
Colm Patrick Finbarr O’Donnell
Keyword(s):  
Heart Rate ◽  
High Risk ◽  
Pulse Oximetry ◽  
Clinical Assessment ◽  
Newborn Infants ◽  
Mean Difference ◽  
Low Risk ◽  
Delivery Room ◽  
Reasonable Accuracy ◽  
High Risk Infants

Clinical assessment of an infant’s heart rate (HR) in the delivery room (DR) has been reported to be inaccurate. We compared auscultation of the HR using a stethoscope with electrocardiography (ECG) and pulse oximetry (PO) for determining the HR in 92 low-risk newborn infants in the DR. Caregivers auscultated the HR while masked to the HR on the monitor. Auscultation underestimated ECG HR (mean difference (95% CI) by −9 (−15 to –2) beats per minute (bpm)) and PO HR (mean difference (95% CI) by −5 (−12 to 2) bpm). The median (IQR) time to HR by auscultation was 14 (10–18) s. As HR was determined quickly and with reasonable accuracy by auscultation in low-risk newborns, study in high-risk infants is warranted.

Oxygenation of the Newborn

2016 ◽  
Vol 10 (2) ◽  
pp. 170-171 ◽  
Author(s):  
Ola D Saugstad
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Necrotizing Enterocolitis ◽  
Gestational Age ◽  
Obstet Gynecol ◽  
Positive Pressure Ventilation ◽  
Newborn Infants ◽  
Delivery Room ◽  
Positive Pressure ◽  
Risk Of Mortality

ABSTRACT Newborn infants in need of positive pressure ventilation at birth should initially be given 21% O2 from term to gestational age 33 weeks. Gestational ages 29-32 weeks could be given initially FiO2 of 0.21-0.30. For ≤ 28 weeks FiO2 of 0.30 or more should be given initially. FiO2 should then be adjusted according to the oxygen saturation response assessed by pulse oximetry. After delivery room stabilisation oxygen saturation targets of 85-89% increases the risk of mortality and necrotizing enterocolitis. In spite an oxygen target of 90-95% increases the risk of ROP this is presently the recommended range. How to cite this article Saugstad OD. Oxygenation of the Newborn. Donald School J Ultrasound Obstet Gynecol 2016;10(2):170-171.

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